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Iatrogenic splenectomy during nephrectomy for renal tumors
Author(s) -
Wang Jeffrey K,
Tollefson Matthew K,
Kim Simon P,
Boorjian Stephen A,
Leibovich Bradley C,
Lohse Christine M,
Cheville John C,
Thompson R Houston
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12065
Subject(s) - medicine , splenectomy , nephrectomy , odds ratio , perioperative , hazard ratio , surgery , logistic regression , complication , risk factor , kidney , confidence interval , spleen
Objectives To evaluate risk factors associated with iatrogenic splenectomy during nephrectomy and to assess outcomes among patients undergoing nephrectomy for renal tumors. Methods Of 4323 patients who underwent nephrectomy at M ayo C linic between 1992 and 2008, 33 (0.8%) had an iatrogenic/unplanned splenectomy. In a case–control study design, controls without splenectomy were matched 1:3 based on age, sex, surgical date, side of the renal tumor, surgical approach and surgeon. Perioperative features and survival were evaluated using conditional logistic and C ox regression. Results Among the 33 iatrogenic splenectomy patients, the majority (94%) underwent radical, open and left‐sided nephrectomy. Primary tumor classification ≥ T 3 was the only clinicopathological risk factor significantly associated with splenectomy (odds ratio 3.4; P = 0.02). Compared with controls, patients with an iatrogenic splenectomy were more likely to have longer operative time (205 vs 171 min; P = 0.02), higher estimated blood loss (1.3 vs 0.3 L ; P = 0.001), longer length of stay (median 7 vs 5 days; P = 0.03) and a higher likelihood for postoperative complications (odds ratio 5.3; P = 0.002). With a median of 9.8 years of follow up, splenectomy patients tended to have greater all‐cause mortality (hazard ratio 1.6; P = 0.07), although this difference approached statistical significance. Conclusions Iatrogenic splenectomy is a rare complication during nephrectomy and is associated with locally advanced tumors (≥ pT3 ). It also carries prognostic significance for adverse perioperative outcomes and possibly diminished survival, although this warrants further study.